Value-based care translates to payment models that incentivize high-quality, medically appropriate services rather than volume -- a dramatic switch for radiology, which for years has been encouraged to maximize volume without regard for appropriateness or quality, wrote the group led by Dr. Farouk Dako from Temple University Hospital in Philadelphia. That situation must change, however.
Dr. Farouk Dako from Temple University Hospital.
"To expand the role of radiology in providing cost-effective quality healthcare, we must find ways to improve processes and structures that have not traditionally been measured and demonstrate how they influence system-wide performance," they wrote. And we "need to increase our impact by not limiting our quality improvement efforts to the radiology department."
Dako and colleagues offered three ways radiologists can expand their role in a value-based healthcare economy (JACR, January 23, 2017).
1. Be proactive with follow-up
"Coordinated care" is increasingly emphasized in the healthcare enterprise, and radiologists can play a role in it by helping referring physicians manage incidental findings -- which often fall outside of the ordering physician's practice scope, the authors wrote.
An example? Following up a complex renal cyst identified on an MRI scan of the lumbar spine that was ordered by an orthopedic surgeon. Keep in mind that "closing the communication loop" through a documented phone call to the surgeon is not enough. "We know that a lot of these findings end up not being followed up or are followed up inappropriately," the team wrote. "We can increase our value in a coordinated healthcare system by communicating directly with patients and adding incidental findings to the patients' list of health problems."
Dako and colleagues also suggested that radiologists collaborate with their clinician peers to establish follow-up clinics patients can attend for further consultation.
2. Be active consultants
Radiologists should actively assert their role of consultant to clinician peers, helping them choose the right study and protocol based on the patient's symptoms, the authors wrote.
This means "expanding on traditional questions regarding indications and contraindications of studies, improved communication with clinicians, and helpful inquiry to ensure that a study is not just indicated to answer a generic clinical question but is ideal for the patient at a specific point in time," according to Dako and colleagues.
To do this well, radiologists must be confident in their knowledge about the appropriateness of various studies, and be able to focus less on the fee-for-service model and more on patient-centered care.
3. Think across the enterprise
Radiologists must constantly search for ways outside of the radiology department to improve performance system-wide, according to the authors. One example might be to help define appropriateness criteria for the use of central venous catheters; another could be creating best-practice guidelines for image-guided procedures that are also performed by other specialties.
Finally, Dako and colleagues suggested that radiologists help establish pulmonary embolism response teams, composed of emergency medicine and critical care physicians and radiologists.
"Through teams like this, radiologists can become more involved in both the diagnosis and treatment of patients and work with other departments to coordinate care and reduce time to treatment," they wrote.
What's the overall takeaway? Radiologists should broaden their role in the healthcare enterprise, according to Dako and colleagues.
"Radiologists will need to move toward an expanded role that more directly engages patients and clinical processes outside of the radiology department to succeed in the new value-based economy," they concluded.
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